Arizona will soon allow access to birth control pills without prescription

Women in Arizona will soon find it a lot easier to get birth control.

Starting in July, on a date yet to be set, Arizona pharmacists will, for the first time since birth control pills were authorized in 1960, be allowed to dispense them without women having to present a prescription.

Ditto for the more recent hormonal contraceptive vaginal ring and hormonal contraceptive patches.

It won’t be quite the same as grabbing a bottle of cough medicine off the shelf. Women will still need to answer some questions from the pharmacist to determine if the hormones will be safe and appropriate for them.

But gone will be the need to first go to a doctor for an initial prescription or for annual renewals. Replacing that will be a “standing order’’ from a doctor at the Arizona Department of Health Services permitting pharmacists to dispense contraceptives if they first question would-be customers about their individual risks.

There was some concern expressed by lawmakers about skipping medical exams when they set the process in motion two years ago. But the consensus was that the benefits of on-demand hormonal birth control outweighed the risks of not having regular doctor visits.

Debate over the new law

The debate when lawmakers considered the issue in 2021 was how difficult it should be for women to avoid conception.

“Pregnancy should be the decision of the woman,’’ said Rep. Athena Salman, D-Tempe. “Right now women face barriers in our community because they don’t have access to doctors for a variety of reasons, one of which is because health care premiums keep going up. We should be making it as accessible as possible for women who want to plan their pregnancies to be able to do that.’’

During debate, no one spoke against the idea of easier access to pills and devices containing hormones that block ovulation.

But several lawmakers wanted more guardrails.

Joanne Osborne, then a Republican representatives from Buckeye, said she had no problem with women getting up to two years of refills without having to go back to a doctor.

She proposed, however, that any initial prescription require an order from a physician. She also suggested requiring new medical assessments by the woman’s primary care physician every other year.

The idea of being able to get contraceptives without first seeing a doctor also bothered Regina Cobb, a Republican who represented Kingman.

Cobb, who is a dentist, said regular visits are designed to ensure the chemicals in the contraceptive devices are not causing problems. She noted a link between certain types of birth control, particularly those using estrogen, and potentially fatal blood clots.

“Prescribing without actually doing a complete exam and questionnaire from a medical professional I think is irresponsible,’’ Cobb said.

Law written to address risks

But Will Humble, executive director of the Arizona Public Health Association, told Capitol Media Services on Wednesday that the law that will soon take effect is a good balance between risk and benefits.

“On the risk side of things, there’s a chance — and probably a good chance — that some women will skip that routine care, Pap smears and things like that,’’ he said, referring to tests that can detect cervical cancer.

Beyond that, Humble said, there are some conditions that put women who take oral contraceptives at higher risk for blood clots.

The legislation is written to address that issue.

It requires pharmacists, before dispensing any pill or device that has hormones, to ask patients to fill out a self-screening risk assessment designed to determine whether there are any indications contraceptives may not be appropriate.

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The specific form is being finalized by the Arizona Department of Health Services.

That’s part of the reason there is no firm date for when the contraceptives will be available without an individual prescription.

Questions women might be asked

But by law, that form must be based on nationally recognized guidelines. And forms from other states give a good clue of what women here will be asked.

For example, the form being used in California inquires about things like whether a woman has used hormonal contraceptives in the past and, if so, has suffered any adverse reaction.

There are also questions about risk factors, such as whether someone smokes, has diabetes, has given birth within the past six weeks, has high blood pressure, or is currently breastfeeding an infant younger than one month.

Cobb was unimpressed with the idea the self-assessment is sufficient to protect patients.

During debate, she said her own patients, filling out questionnaires at her office, might answer one way in writing. But when questioned in person, where more detail can be solicited, sometimes the answers change, she said.

Strictly speaking, nothing in the law or the rules enacted by the Board of Pharmacy say an affirmative answer to one or more of those questions disqualifies a customer from getting the pills. Instead, that is left to the judgment of each individual pharmacist.

The rules, however, require pharmacists who do want to dispense birth control without individual prescriptions to have at least three hours of continuing education every two years.

The law also provides protections for those who participate. It says that pharmacists who act “reasonably and in good faith’’ are “not liable for any civil damages for acts or omissions resulting from dispensing that self-administered hormonal contraceptive.’’

“Ability to control reproduction”

All that goes to what Humble said is the benefit side of the equation.

“It just makes it that much easier for women to access birth control and their ability to control reproduction and have autonomy over that side of things,’’ he said.

Humble said health issues like this are rarely black and white. He compared the risk-benefit analysis here to when Arizonans voted in 2020 to legalize marijuana for recreational use.

“The upside was criminal justice reform,’’ he said, as it allowed the legal purchase of the drug from state-regulated dispensaries and eliminated the risk of jail time for users. “The downside was it makes it easier for adolescents to get access to weed.’’

Part of the reason it’s taken until now for the 2021 law to take effect is the statute required the state Board of Pharmacy to write rules, submit them for public comment and ultimately get final approval from the Governor’s Regularly Review Council. That is set to happen next week.

There is precedent for the idea of having the health department write a standing order that can replace individual prescriptions.

It used to be that individuals needed a doctor’s permission to obtain naloxone, formerly marketed under its brand name Narcan. That drug can reverse an opioid overdose by blocking the effects of the drug on the brain and restoring breathing.

During a spike in opioid deaths, then-Gov. Doug Ducey, a Republican, signed an order directing the health department to issue a standing order allowing anyone to purchase naloxone. That was designed to ensure that families could have it easily available should someone overdose.